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3177469 tn?1344454268

Treating while on Suboxone

I have been taking Suboxone for more than a yr. now.  I've also started triple therapy with Victrillis.  I'm to start taking the Victrillis this Friday.  Why is buprenorphine, [suboxone], on a list with medicines where therapy is to be monitored more closely while taking Victrellis?  Will treatment be harder because or suboxone?  I'm a relapser. 3 yrs. ago I was treated with Pega. Riba. and relapsed 6 months after treatment.  I was on a Methadone program then.  Had a rough time with treatment; but I did stay the course, 48 wks.  My geno. is 1A, and I'm at stage 3.  Why is Suboxone on this list and not methadone?  I thought I was doing a good thing getting off methadone and switching to suboxone.
Any advice is appreciated.     Sincerely,  jts
Best Answer
766573 tn?1365166466
It isn't really about monitoring you per se - rather it is about monitoring your response to the HCV med. I have had friends who are on MMT say they do not require as much of a maintenance dose because the protease inhibitor increases the concentration of the med they are taking while on maintenance.  

Usually when a med is contraindicated (or monitored as you say) it has to do with the way one or both meds is metabolized or the way it interacts with another med. For example the Beoceprevir may increasse the concentration of The Suboxone so a dose adjustment might be required.

You might want to post the name of the source where you heard this so we can be sure it matches this info.

Here is a link:
http://www.hepatitis-central.com/victrelis_boceprevir_contraindications.html

This is from the chart about half way down the page.

When is Victrelis™ contraindicated?

The same contraindications that pertain to peginterferon and ribavirin also apply to the Victrelis™ combination treatment. This combination treatment is contraindicated in the following:

♦ Pregnant women and men whose female partner is pregnant due to the risks for birth defects and fetal death associated with ribavirin.

♦ Coadministration with drugs that are highly dependent on CYP3a4/5 for clearance, and for which elevated plasma concentrations are associated with serious and/or life-threatening events including

Narcotic Analgesic/Opioid
Dependence: methadone (Dolophine®),
Buprenorphine (Butrans®, Buprenex®, Suboxone®, Subutex®)

Effect on Concentration of Boceprevir or Drug
Increases or decreases methadone
Increases or decreases buprenorphine
20 Responses
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3177469 tn?1344454268
Hi Will, Originally I started triple treatment with Incivik.  I followed all the directions; taking the correct amount of fatty food with the Incivik, etc.  By day 2 I'm gaging on the medicine and forcing myself to eat. Day 3 I'm vomiting and can barely drink water.  I had to stop treatment.  I was in bed for 4 days afterwards, unable to eat .  About a month latter I started triple treatment with Victrillis.  My doctor felt the 4 days I was on Incivik won't compromise my chance of being cured with Victrillis.  I'm finding the Victrillis challenging but much easier.      Jim
Helpful - 0
Avatar universal
was really apprehensive about adding the Victrillis to my treatment; considering the bad time I had with Incivik.
---------------------------------------------------
You treated with Incivek and are now treating with Victrelis?? Why?

Thanks...
Will

Helpful - 0
Avatar universal
Suboxone makes some people ill from the naloxone - ask for Subutex. Why save your liver if you are risking relapse? Why, are addicts not worthy of saving? Using drugs (other than alcohol and many pills) does not always hurt your liver. I was an IV heroin addict using 2+ grams a day for 10yrs, with a co-infection of HCV and HBC and I have no fibrosis. I do not think the 2 have to be mutually exclusive. My only concern with tx an addict is that their use may keep them from taking their meds correctly, and they may become resistant if that happens and not be able to successfully treat again.
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3177469 tn?1344454268
I'd like to thank everyone for helping me with my question.  I was really apprehensive about adding the Victrillis to my treatment; considering the bad time I had with Incivik, and the sick feeling I was getting from Suboxone.  But after taking Victrillis for 4 days now, I'm doing alright.  Thanks again.   Jim
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3177469 tn?1344454268
Thanks nygirl, Congratulations on being SRV. I'm taking 16mg of suboxone a day.  After starting treatment I felt I needed more. Was having withdrawal everyday.  Now that I've added Victrillis , I think I'll be able to manage on my regular dose. As long as the side effects don't get any worse. No way I would ever want to get off the suboxone before starting treatment
Thank You for your support.   Jim
Helpful - 0
317787 tn?1473358451
Hey girl!  From everything I have read, the subs and methadone do not interfere with the SOC either alone or with the new PI's
You did good!
Helpful - 0
179856 tn?1333547362
Ps you know Doctors are hesitant to prescribe subtext instead of suboxone because they want you to have the naloxone, it makes sense. Where is the sense of trying to save your liver only to start getting high?

Sorry iPad keeps spell checking the word to subtext I know that's not it.
Helpful - 0
179856 tn?1333547362
Ok I treated while on subs. But, it was with the old SOC no PI involved. Had a great initial response then hit a plateau. Got stuck at 411 and didn't get to Und until after week 12. Back in the day the only option for me was to do 72 weeks. I've been SVR for five or six years now.

The thing people don't understand is you need to keep takings the subs. The risk otherwise is too great. I finally weaned off them about a year and a half ago. It was hard and for a year I thought about them every day.

I just took my regular 24 mg a day during tx. Did it cause me to have such a tough time to get to Und? I don't know.

But with life you gotta do what you gotta do.

Just go for it and win.

Best of luck I know it's not easy but in my opinion going through withdrawal and starting tx would be way too hard. WAY too hard. It's up to you to decide if you can wait tx for six months and detox them (so hard but possible:) or give it a shot now.

All the data you have seen only applies to SOC so it's NOT relevant now.
There are no studies done yet to my knowledge that include a PI. Those studies are years old, I read them in 2005.

So have hope.

Best of luck
Deb
Helpful - 0
766573 tn?1365166466
Here's a study: The Effect of Telaprevir on the Pharmacokinetics of Buprenorphine in Volunteers on Stable Buprenorphine/Naloxone Maintenance Therapy

This was an open-label, single-sequence trial in HCV-negative volunteers on stable, individualized, buprenorphine maintenance therapy. Telaprevir 750mg every 8 hours was co-administered with buprenorphine/naloxone (4:1 ratio as sublingual tablets) for 7 days with food. Pharmacokinetic profiles of buprenorphine, norbuprenorphine and naloxone were measured over the 24-hour dosing interval on Day –1 (buprenorphine/naloxone alone, reference) and Day 7 of telaprevir co-administration (test). Geometric least squares mean ratios and associated 90% confidence intervals of treatment ratios (test/reference) were calculated using log-transformed pharmacokinetic parameters. Opioid withdrawal symptoms were evaluated throughout the study (questionnaires and pupillometry). Pharmacokinetic data were available for 14 and 13 volunteers on Day –1 and Day 7, respectively. AUC for buprenorphine was unchanged, and Cmax for buprenorphine, Cmax and AUC for norbuprenorphine, and Cmax naxolone were modestly decreased, during coadministration with telaprevir. Geometric least squares mean ratios (90% confidence intervals) for buprenorphine were 0.80 [0.69, 0.93] for Cmax and 0.96 [0.84, 1.10] for AUC0-24h; for norbuprenorphine were 0.85 [0.66, 1.09] for Cmax and 0.91 [0.71, 1.16] for AUC0-24h; and for naloxone were 0.84 [0.62, 1.13] for Cmax.

Co-administration of telaprevir did not increase withdrawal symptom frequency and there were no serious adverse events reported during or after completion of telaprevir co-administration.

Results suggest dose adjustment may not be necessary when telaprevir and buprenorphine/naloxone are co-administered.
http://aac.asm.org/content/early/2012/05/02/AAC.00077-12.abstract

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3177469 tn?1344454268
Thanks mythoughts and willbb for good answers,      Jim
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Avatar universal
Opioid Substitutes

Methadone and buprenorphine are both partially metabolized by CYP3A4.9 With boceprevir, concentrations of methadone or buprenorphine may either increase or decrease.1 With telaprevir, methadone concentrations are reduced.2 Patients on methadone or buprenorphine should be monitored during anti-HCV triple therapy to determine if a dose adjustment of the opioid substitute is needed.1,2


http://lmt.projectsinknowledge.com/Activity/index.cfm?showfile=b&jn=2037&sj=2118.02&sc=2118.02.6

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Avatar universal
Suboxone has naloxone/naltrexone in it, while subutex does not. That drug is not liver friendly, so that is likely the reason. Docs should give Siubutex, but theyt have some idea that adding a drug that precipitates withdrawl if you use will discourage relapse. You may want to discuss getting Subutex with your doc. As far as I know, Bupe is not a good option for HCv positive people. I have been a patient advocate for opioid dependant people for over 10yrs.
Helpful - 0
766573 tn?1365166466
Sorry, I wasn't sure how much you knew. I hope the few days you took the Incivek do not matter. Boceprevir has its share of sides but from what I have learned here on the forum they are not the same sides as the Incivek. At least not with the nausea & the fat requirement.

I do not think you will react the same. It is good you have the Procrit lined up. Keep in touch and let us know how things are going♫
Helpful - 0
3177469 tn?1344454268
Thanks Idyllic.  I originally started triple treat. with Incivik.  Started May 25.
My last dose was 3 days latter. I couldn't eat because of vomiting.  For 4 days after I couldn't eat and barely drink a little water. I know that once your'e treated with a protease inhibitor, you can't be treated again; but my doctor said the 4 days on Incivic won't compromise my chance of being cured with Victrellis.  I am anxious about starting the Vic. I just hope I don't react the way I did to Incivik.  I'm not one to quit easily; but I have to be able to get out of bed and do some work.  I'm already taking Ondansetron ODT 4MG, because I seem to be nauseas all the time.  I have asked for Procrit , but my count is at 11.  When it gets below 10, they'll prescribe it.  Would like to keep in touch and tell how I'm doing on the Vic.
Thanks for the support.    Jim
Helpful - 0
766573 tn?1365166466
Hey Jim, I so your other post wondering if the Suboxone would interfere with your treatment. First of all, sorry no one responded ~ that thread is three years old; so while the search function on this site is semi-reliable for informative purposes sometimes starting a new thread will yield a response much sooner.

Since you are starting the Vic this Friday that means you have been on Peg & Riba for a couple of weeks. I realise your primary question is whether Suboxone would interfere with your treatment since you are not feeling so great but I wanted to mention a few things since the Suboxone might not be that much of a factor - it just depends.

Anxiety about adding the Vic to your routine is well founded as the protease inhibitors (PI's) come with their own set of side effects. An annoying one is a constant bad taste in your mouth that even makes food not very tasty. I have heard if you drink chocolate milk with your dose that it helps though...no one on here has really echoed that.

Next, a very common side is called  haemolytic anaemia (a form of anaemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs). Since you will be having labs fairly often in the beginning be sure to keep an eye on your haemoglobin (HGB). Usually if it drops below 10 an intervention such as Riba dose reduction or starting you on a med called Procrit helps. You are less tired, able to regain your breath and have some of your old stamina.

If you are not doing so already be sure to obtain copies of all your labs within days of having your blood drawn. Your medical records are yours and that way if you have questions you can post and the people on here will respond.

I don't know how much of this you know already but part of the reason I am mentioning these things is that it is possible to feel completely lousy without it having anything to do with your recovery or the Suboxone. I guess I am trying to reassure you that your discomfort may have zero to do with being an addict. As a recovering addict myself I balked in the beginning and tried to tough things out until I discovered that many of my side effects were treatable.

There is no reason for you to walk around feeling sick or miserable if this is the case with you. I encourage you to have a med check with the doc who prescribed your Suboxone but I even more I encourage you to learn more about the meds you are taking. Interferon, Ribavarin and Victrellis come with their own set of side effects. Maybe later you can post again and describe how you feel. That way you might be able to differentiate between the two.

Just remember we are all here and you don't have to go through this alone.
Hang in there!!
Helpful - 0
Avatar universal
  Well, good luck, and remember to sip tons of water. I also ate alot of nutritious, wholesome food, to stay feeling okay.
   There are more side effects, once the Victrelis is introduced, what is bothering you now?
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3177469 tn?1344454268
Hi Idyllic,  Thanks for a great answer. My source is the medication guide that came with the Victrellis.  At the bottom of the page it states:  Your healthcare provider may need to monitor your therapy more closely if you take Victrellis with the following medications:  alprazolam, amiodarone, atorvastatin, bepridil, bosentan, budesonide, buprenorphine, cyclosporine, desipramine, digoxin.
It doesn't mention methadone.  Makes me wonder if treatment is harder with buprenorphine.  I can only hope it's not.    jts.
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3177469 tn?1344454268
Thanks Gal,  I was just curios as to why their on the list.  Would being on one or the other be better.  I'm not feeling well at all, and I start taking Victrellis this Fri.  
Helpful - 0
Avatar universal
I'm no expert, and not sure, but it is prob like what Idyllic says, you may need less subutox while on the Triple Tx...and also, you may tend to get anemia quicker, from being on that particular drug.
  But I remember seeing methadone on the list beore, also...I think both scenarios are monitored more closely. I also know a whole bunch o olks who have successfully Txed while on those.
   Pay careful attention to how you are feeling~
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